Breast Surgery – Incision Decision – Endoscopic vs. Areolar vs. Inframammary

If you’re contemplating breast augmentation surgery you and your surgeon will need to decide on the incision that will be used to place the implant. Your body type, aesthetic goals and implant choice all contribute to the selection of incision used for your breast augmentation. We’ve listed three different types of implant incision and explained what makes them different:

Endoscopic breast augmentation (minimal incision) refers to the insertion of an implant through an axillary incision (an incision in the armpit) using an endoscope (a small camera). An incision is made in a natural armpit crease, and a channel into the breast is opened up. The implant is inserted through the incision and moved through the channel, then positioned and centered behind the nipple. This operation is suitable for saline implants as well as silicone gel devices, and has the advantage of hiding the scars in the armpit. However, it may be difficult to revise the procedure if you are not satisfied with the results or if complications arise.

The areolar incision is made on the outline of the areola (the pigmented skin surrounding the nipple), usually from the 8:00 to the 4:00 position. The goal is to place the incision at the border between the areola and surrounding skin to reduce the visibility of the scar.

This incision is suitable for saline implants, as they are nearly empty during insertion. Silicone-gel implants may also be used depending on their size and the size of the areola. Once the areolar incision is made a pocket is created and the implant is placed in the pocket. The implant is then centered behind the nipple.

The inframammary (under the breast) incision is appropriate for all available implants.

The inframammary incision is placed in the fold where the breast and the chest come together (inframammary fold). A pocket is then created and the implant is inserted by sliding the implant up through the incision. The implant is then centered behind the nipple.

The incision is located in a way that allows for the optimal placement of the implant. This method also gives the surgeon greater control and access to the tissues. The scars from this incision will be hidden under the breast, allowing the patient to wear a wide variety of fashions while still hiding the scar.


Whichever breast augmentation incision appeals to you, this decision should be made after careful consideration and discussion with your plastic surgeon. Dr. Pugash will thoroughly review your breast augmentation options during your consultation. You can schedule a consultation by calling our offices at (604) 522-5199.